<form method="post" name="frm" action="{$action}">
<div class="main_header">SIGN UP FOR NEW ACCOUNT</div>
<table width="400" border="0" cellspacing="0" cellpadding="5" class="tblfrm">
  
  <tr>
    <td width="38%">Login Name</td>
    <td>: 
      <input type="text" name="username" style="width:210px" value="{$username}" maxlength="100"  class="textinput" />
  </td>
  </tr>
  <tr>
    <td>Complete Name</td>
    <td>: 
      <input type="text" name="name" style="width:210px" value="{$name}" maxlength="100"  class="textinput" /></td>
  </tr>
  <tr>
    <td>Password</td>
    <td>: 
      <input type="text" name="newpassword" style="width:210px" value="" maxlength="50"  class="textinput" /></td>
  </tr>
  <tr>
    <td>Confirm Password</td>
    <td>: 
      <input type="text" name="retypepassword" style="width:210px" value="{$name}" maxlength="50"  class="textinput" /></td>
  </tr>    
  <tr>
    <td width="150">Email Add</td>
    <td>: 
      <input type="text" name="email" style="width:210px" value="{$email}" maxlength="100" class="textinput"  /></td>
  </tr>
  <tr>
    <td width="150">Birthday</td>
    <td>: 
      <input type="text" name="birthday" style="width:210px" value="{$birthday}" maxlength="100" class="textinput"  /></td>
  </tr>
  <tr>
    <td width="150">Address</td>
    <td>: 
      <input type="text" name="address" style="width:210px" value="{$address}" maxlength="100" class="textinput"  /></td>
  </tr>
  <tr>
    <td width="150">City / Province</td>
    <td>: 
      <input type="text" name="city" style="width:100px" value="{$city}" maxlength="100" class="textinput"  /></td>
  </tr>    
  <tr>
    <td width="150">Country</td>
    <td>: 
      <select name="country" id="country" style="width:200px">                    
{html_options options=$countries selected=$country}
          </select></td>
  </tr>  
  <tr>
    <td width="150">&nbsp;</td>
    <td><div style="text-align:right; margin-right:7px;padding-right:14px"><input type="button" onClick="window.location='{$link_return}';" value="Cancel" > <input type="submit" name="" value="Submit" ></div></td>
  </tr>
</table>
	<input type="hidden" name="task" value="save" />
</form>